CMS Announces Proposed Rule for ACOs

CMS announced a major change coming for Accountable Care Organizations (ACOs) in a 607-page proposed rule and a Health Affairs article from CMS Administrator Seema Verma today. The rule will cut the time ACOs can remain in the program without assuming risk from six years to two years. Under current regulations, only one in five ACOs are currently at risk of losing money in the Medicare Shared Savings Program, as the majority of ACOs have chosen "Track 1," in which ACOs can share in savings if they hit key goals but are not at risk. This is especially true in rural America where razor thin margins means that the cost of implementing the changes to be a part of an ACO is a significant source of risk already.
 
Under the proposed new rule, the three-track program would cut to two options: “a "BASIC" path that steadily ramps up risk, and an "ENHANCED" path that would allow providers to immediately qualify as an Advanced Alternative Payment Model under Medicare's physician payment law.” In the rule, CMS predicts that 109 current ACOs, or approximately one in five, will drop out of the program in the next ten years. Likely more of the ACO participants that will be forced to drop out will be small and rural providers.
 
NRHA is examining this rule in greater detail and will continue to monitor proposed changes for ACOs from CMS, seek your input, and will post comments on the regulatory section of ruralhealthweb.org once submitted. You can view the rule here.